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NURS 3512 acute & chronic > Week 4 vavlular and Vascular Lecture > Flashcards

Week 4 vavlular and Vascular Lecture Flashcards

1
Q

What does stenosis mean in valvular disease?

A

-Valve opening is narrowed
-blood can’t move forward properly

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2
Q

What is regurgitation in valvular disease?

A

valve fails to close properly and there is blood backflow

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3
Q

What side of the heart do valve disorders more frequently occur?

A

Left side of heart
(Lt receives from lungs, pumps out to body)

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4
Q

what are commonly heard upon ascultation with valvular disease?

A

murmurs

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5
Q

What is Mitral Stenosis?

A

Blood can’t move well from left atrium to L ventricle (narrow)

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6
Q

In mitral stenosis where does blood back up to and what does it cause ?

A

L atrium and lungs
atrial enlargement/hypertrophy
pulmonary congestion

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7
Q

What is a later stage of mitral stenosis and what does it cause?

A

back up to R ventricle
Rt sided HF

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8
Q

What are the major symptoms of mitral stenosis?

A
  1. SOB
  2. dyspnea upon exersion
  3. hemoptysis
  4. A fib
  5. stroke (emboli due to blood stasis from afib)
  6. eventually Rt sided HF (backs up into system- edema, JVP)
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9
Q

What is mitral regurgitation?

A

-valve doesn’t close properly
- blood flows back to Lt atrium and then goes back into Lt ventricle so there’s too much blood in there

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10
Q

What can mitral regurgitation result in?

A

Shock
dyspnea

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11
Q

What can mitral regurgitation lead to?

A

Rt. sided HF (JVP, peripheral edema)

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12
Q

What is mitral prolapse?

A

valve leaflets enlarge and prolapse into the atrium

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13
Q

Mitral prolapse is usually asymptomatic but patients can eventually feel what symptoms?

A
  1. chest pain
  2. exercise intolerance
  3. dysrhythmias
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14
Q

What is aortic stenosis?

A

Obstruction of blood flow between left vent and aorta (not atrium)

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15
Q

What does Aortic stenosis cause?

A

L vent hypertrophy
decreased CO

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16
Q

What are the classic symptoms of Aortic stenosis?

A

syncope
angina
dyspnea upon exertion

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17
Q

What med should we be cautious to give to people with aortic stenosis and why?

A

Nitro
b/c preload has to be maintained in order to force the valve open

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18
Q

When is surgery done for someone with aortic stenosis?

A

When the valve is less than 1cm = <1 cm

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19
Q

what is aortic regurgitation?

A

valve doesn’t close completely
blood backs up from the aorta (not atrium) to Lt vent

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20
Q

What part of the heart mechanics does aortic regurgitation impact?

A

pumping action - ineffective
b/c Lt. vent. hypertrophies

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21
Q

What are the signs of aortic regurgitation ?

A

low CO
hypotension (low BP)
Shock
PROFOUND DYSPNEA
angina

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22
Q

What are the 5 points of data we collect (Assessment) for someone with valvular heart disease?

A
  1. family HX
  2. crackles - pulmonary congestion
  3. murmurs - heart sounds/pulses
  4. peripheral edema (pulses)
  5. decreased CO - perfusion to organs such as kidneys
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23
Q

What are the 3 main PMHX things we should ask about in someone with valvular heart disease?

A
  1. previous rheumatic fever
  2. previous endocarditis
  3. hx of IV drug abuse
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24
Q

What are the 4 diagnostic tests for valvular heart disease and what do they test for?

A
  1. Echocardiography (structure & movment of heart) - ultrasound of heart
  2. Exercise tolerance test (determines severity)
  3. Chest xray (atrial and vent. enlargement)
  4. EKG (dysrhythmias)
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25
Q

What are 5 non-surgical interventions for someone with valvular heart disease?

A
  1. drug therapy and rest
  2. prevent exaacerbations of PE, thromboembolsim and endocarditis
  3. anticoagulant therapy (warfarin)
  4. antidysrhythmic drugs or cardioversion (if Afib)
  5. treat HF if it develops
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26
Q

What are 4 procedural/surgical interventions for people with valvular heart disease

A
  1. balloon valvuloplasty
  2. TAVR (transcatheter aortic valve replacement)
  3. Valve repair
  4. Valve replacement
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27
Q

What’s a major concern for someone with a mechanical valve?

A

Thromboembolism
- life long anticoagulants and blood monitoring

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28
Q

What are we worried about with biologic valve?

A

calcification

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29
Q

What valve cannot be replaced with a biologic valve and why?

A

Aortic valve
b/c increase pressure

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30
Q

Which kind of valve replacement requires anticoagulants for life, Mechanical or biologic?

A

Mechanical valve only

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31
Q

what do we teach people with valvular disease?

A
  1. exercise plan to increase cardiac tolerance
  2. REST between activity
  3. Fluid overload - wt gain, perf. edema, crackles to lungs
  4. less salt - avoid caffeine
  5. O2 if needed
  6. prophylactic antibiotics b/f invasive surgery/diagnostic procedure/dentist
  7. no smoking
  8. mechanical valve = anticoags for life
  9. take meds
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32
Q

What is Cardiogenic shock?

A

HEART CAN’T PUMP d/t damage
emergency

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33
Q

What is Cardiogenic shock most often associated with?

A

acute MI

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34
Q

what is the big difference between cardiac shock compared to other shock?

A

RAPID fluid replacement can CAUSE FURTHER DAMAGE

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35
Q

What is the goal for someone with cardiogenic shock?

A
  1. restore blood flow to myocardium
  2. allow perfusion
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36
Q

What is infective endocarditis?

A

-Infection of heart valves and/or endocardial surface of the heart
- vegetations form

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37
Q

What is infective endocarditis caused by?

A

Bacteria (staph, strep) in blood stream
Viruses
Fungi

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38
Q

what conditions predispose someone to developing infective endocarditis?

A
  1. Prior endocarditis
  2. damaged valves
  3. IV drug use
  4. Hospital aquired bacteremia
  5. Rheumatic heart disease
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39
Q

How do infecting organisms enter the body leading to infective endocarditis?

A

-Oral cavity
-Skin rashes /lesions/abscesses
- infections (cutaneous, GI, GU)
- surgery or invasive procedures (IVs, CVADS)

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40
Q

Symptoms of infective endocarditis

A
  1. Low grade fever- infection
  2. Malaise - body fighting
  3. Chills - temp reg issues
  4. anorexia - GI affected
  5. back pain
  6. Headache
  7. weight loss
  8. Myalgia
  9. heart murmurs
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41
Q

Vegetations can fragment and migrate. What two types of embolism does it cause?

A
  1. Organ embolization
  2. Vascular embolization
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42
Q

Which embolization is more painful when a vegetation fragments or migrates?

A

organ embolization

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43
Q

What parts of the body/organs are affected in organ embolization?

A

Brain
Spleen
Kidneys
Lungs
GI tract
arms and leg vessels

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44
Q

What type of skin issues does Vascular embolization cause?

A

-Splinter hemorrhages (nails)
-Petichia
-Janeaway’s lesions (hands/feet)
-Roth’s spots (eyes)

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45
Q

What 2 lab assessments do we use for infective endocarditis?

A

-Blood cultures
-CBC might show increased WBC

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46
Q

What diagnostics are used for infective endocarditis?

A

echocardiogram - shows how well heart chambers are pumping
1. standard thoracic (ultrasound)
2. transesophageal echocardiogram (esophagus)

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47
Q

What do we monitor in people with infective endocarditis?

A
  1. fever
  2. decreased perfusion (LOC, low urine output)
  3. complications from vegetations (LOC, dyspnea, pain)
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48
Q

What types of emboli can form with vegetations?

A
  1. cerebral emboli
  2. pulmonary emboli
  3. renal emboli
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49
Q

What should patients do who have infective endocarditis ?

A

-avoid excessive fatigue
-rest before and after activity
-physical/emotional rest

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50
Q

What are the 2 things to determine with infective endocarditis?

A
  1. Cause (IV drug use, dental visit, procedure, valve disease)
  2. damage (bloodwork, CXray, ECG, EKG)
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51
Q

What are the 4 things to teach patients with Infective endocarditis?

A
  1. prophylactic antibiotics before dentist or surgery
  2. maintain good oral hygene
  3. avoid people with infections
  4. valve replacement maybe
52
Q

What is acute pericarditis?

A

-inflammation of pericardial sac

53
Q

what are the 6 causes of acute pericarditis?

A
  1. autoimmune disease
  2. bacterial
  3. idiopathic
  4. post MI
  5. radiation
  6. Viral
54
Q

Symptoms of acute pericarditis

A
  1. sharp chest pain - increases with breathing
  2. worse pain when lying flat- better sitting forward
  3. *pericardial friction rub - high pitched grating sound
55
Q

What is the hallmark sign of acute pericarditis?

A

pericardial friction rub

56
Q

What are 2 complications of acute pericarditis?

A
  1. pericardial effusion - fluid btwn visceral & fibrous layer
    - pressure on pulmonary tissue & laryngeal nerve)
  2. Cardiac tamponade - intrapericardial pressure = decreased CO = hypotension
    - neck veins and jugular veins distended - blood not moving forward * bad
57
Q

What bad sign will we see when cardiac tamponade is present?

A

distended jugular veins and neck veins

58
Q

How do we correct acute pericarditis?

A
  1. high dose inflammatories
  2. bedrest with HOB up (Tripod)
  3. manage pain & anxiety
  4. pericardiocentesis if cardiac tamponade
59
Q

when someone has acute pericarditis and we have to give high dose inflammatories, what do we need to do to ensure patient safety?

A
  1. monitor for GI bleeds
  2. meds to protect GI tract & decrease gastric irritants
60
Q

What does Rheumatic Carditis result from??

A

Results from lack of proper treatment of
1. strep
2. scarlet fever

61
Q

What does Rheumatic carditis damage?

A
  1. endocardium - causes valvular mitral and aortic sentosis or regurgitiation
  2. Pericardium becomes thickened = pleural effusion
62
Q

What is rheumatic carditis characterized by?

A

Aschoff bodies - small nodules in myocardium- replaced by scar tissue

63
Q

What symptoms/signs do we see with rheumatic carditis?

A
  1. tachycardia
  2. enlarged heart
  3. murmurs - pericardial friction rub and pain
  4. ECG changes
  5. evidence of strep
64
Q

What are the 3 things we do to treat rheumatic carditis?

A
  1. antibiotics
  2. rest
  3. treat symptoms
65
Q

What 2 things do we teach people with rheumatic carditis?

A
  1. at risk of reinfection for rest of life
  2. need prophylactic antibiotics before any invasive or dental procedures
66
Q

what heart issues require prophylactic antibiotics before invasive or dental procedures?

A
  1. rheumatic carditis
  2. Infective endocarditis
  3. Valvular disease
67
Q

what do we want to ask someone about who may have/has CAD?

A
  1. comorbidities
  2. chest pain
  3. extremity pain
  4. dyspnea
  5. fatigue
  6. palpitations
  7. weight gain
68
Q

what are the 8 things we look for in patients with valvular heart disease?

A
  1. confusion
  2. cyanosis
  3. dizziness
  4. dyspnea
  5. fatigue & weakness
  6. fainting
  7. hemoptysis
  8. palpitations
69
Q

What vitals will we see in a patient with valvular heart disease?

A
  1. decreased CO - lower BP
  2. increased RR
  3. Fever
  4. Thready pulse
  5. irregular pulse
70
Q

What do we auscultate for in someone with valvular heart disease?

A
  1. dysrhythmias
  2. murmurs
71
Q

What do we assess lungs for in someone with valvular heart disease?

A

crackles, wheezes, hoarseness

72
Q

What does a transesophageal echocardiography monitor?

A

progression of heart disease

73
Q

What does cardiac catheterization monitor?

A
  1. pressure changes in the chambers
  2. quantifies the size of valve openings
74
Q

What do we assess for in PVD regarding
1. General appearance
2. Pedal pulses
3. Assess pain

A
  1. 5p’s, pitting edema, skin & tonails, ulcerations, drainage, skin temp
  2. Pedal pulses. Use doplar if can’t find them
  3. Pain - dull ache, burning when active, pain at rest, intermittent pain
75
Q

What tests are used for PVD?

A
  1. angiography - catheter into artery
  2. doppler ultrasound
  3. MRA - magnetic imagine angiogram
  4. Segmental blood pressures
76
Q

What is the main cause of PAD?

A

atherosclerosis

77
Q

What is claudication?

A

Muscle pain from lack of oxygen triggered by activity and relived by rest

78
Q

Are there symptoms in stage 1 of PAD?

A

no-asymptomatic
no claudication
pp decreased (unnoticed)

79
Q

What is stage 2 of PAD?

A

claudication
- muscle pain
- cramping when exercising
- relieved with rest

80
Q

What is stage 3 PAD?

A

Pain at rest
- relieved when extremities are dependent

81
Q

What is stage 4 PAD?

A

Necrosis/gangrene
- ulcers and black tissue (toes, heel)
- gangrenous odor

82
Q

What are 5 typical signs of PAD?

A

1.Shiny hairless skin cool to touch
2.Skin taught and thin,
3.Thick, brittle nails
4.Diminished/absent pedal pulses
5. Prolonged cap refill

83
Q

What are 3 symptoms of PAD when it’s at it’s severe stage?

A

1.Pallor when leg elevated and
redness when dependent (dependent rubor)
2.Cold gray-blue or dark gangrenous
3.Pain at rest

84
Q

How does MRA help diagnose PAD?

A

contrast die used to see blood flow through arteries

85
Q

How does segmental systolic BP measurement help diagnose PAD?

A

compares the BP between thigh and brachial.
The bigger the difference - the worse it is

86
Q

How does ABI (ankle-brachial index help diagnose PAD?

A

divide the ankle pressure by brachial pressure.
If <.9 then PAD is present

87
Q

How does exercise tolerance test help diagnose PAD?

A

measures pressures when pain OCCURS - while walking

88
Q

How does Plethysmography help diagnose PAD?

A

tracings of arterial blood flow in the limb

89
Q

Where are PAD ulcers usually found?

A

tips of toes and lateral malleolus

90
Q

Are PAD ulcers cool or warm to the touch?

A

cool

91
Q

What’s the FISRT thing we check if patient has arterial ulcers?

A

Pedal pulses!!!

92
Q

What are 4 risk factor modifications for PAD?

A
  1. manage blood glucose
  2. control BP
  3. smoke cessation
  4. lower cholesterol
93
Q

What medications are given for PAD?

A
  1. antiplatelets (ASA) OR Clopidogrel (Plavix)
  2. Pentoxifylline (Trental) - increase RBC flexibility
94
Q

Patients should not have grapefruit juice with which PAD medication?

A

Plavix

95
Q

Heart disease and PAD have the same dietary suggestions. What are the 4 dietary considerations?

A
  1. Healthy weight
  2. low salt
  3. low fat
  4. low cholesterol
96
Q

What is the most important exercise people with PAD can do and why?

A

WALKING!
increases collateral circulation

97
Q

What is the walking regime recommended for PAD?

A

30-40 min/day
3-5x a week
walk until discomfort then rest then resume

98
Q

If patients with PAD have pain at night, how should they position their legs?

A

dependent, below the heart by dangling over the bed

99
Q

What are the 4 interventions for PAD?

A
  1. balloon angioplasty with stent insertion - open artery & stent inserted
  2. arthrectomy - drill like
  3. aortoiliac and aortofemoral bypass - graft vein placed to bypass the block
  4. Femoropopliteal or femorotibial graft
100
Q

After a PAD intervention procedure, what symptoms call for immediate physician intervention?

A
  • change in VS
  • any changes in perfusion
  • changes in sensation or pain
  • signs of bleeding
  • compartment syndrome
  • hematoma
  • thrombosis/embolization
101
Q

What are 3 things the nurse should focus on for the patient post - PAD intervention procedure?

A
  1. move around as soon as possible
  2. aggressive pain management
  3. careful wound assessment - low healing
102
Q

Discharge teaching for PAD

A
  1. Inspect feet/legs daily
  2. protect feet from trauma - shoes
  3. change positions often
  4. control infection - clean & moisturize feet
  5. Cover ulcers with sterile dressing
  6. Rest pain means it’s getting worse
  7. good nutrition/exercise/stop smoking
103
Q

What is acute arterial Ischemia?

A

Sudden blockage in arterial blood supply
- can lead to gangrene in a few hours

104
Q

How do we monitor for acute arterial ischemia?

A

5 P’s
pulse
pallour
pain
paresthesia
paralysis

105
Q

What can PVD lead to?

A

DVT and PE

106
Q

What are 5 cues of DVT?

A

1/Unilateral leg Edema
2.Pain, sense of fullness
3.Hot to touch
4. Systemic temp
5. Positive Homen’s – unreliable test

107
Q

What are the 3 diagnositc tests used with PVD?

A
  1. venous duplex ultrasonography - blood flow
  2. Impedance Plethysmography - assess blood flow
  3. D-Dimer blood test - coagulation, Fibrin, fragments
108
Q

What drugs are used for DVT?

A

tPA through femoral vein into clot

108
Q

What meds are used for PVD?

A

anticoags
- unfractioned heparin or low molecular weight heparin
- warfarin (vitamin K antagonist)
DOAC - rivaroxaban/apixaban
- similar to warfarin
- do not need frequent blood tests

109
Q

What are 2 Intervention procedures for DVT?

A

Thrombectomy - remove clot
Inferior Vena Cava Filtration - a net to catch clots- temporary

110
Q

What are important teachings for anticoag therapy?

A
  • bleeding >15 min call EMS
  • no NSAIDS or ASA - risk of bleeding
  • Meds same time daily
  • blood work
  • signs of bleeding
  • avoid high risk for bleed activities - sports, soft toothbrush, electric shaver
  • limit alcohol
  • medic alert bracelet
  • let health care providers know about anticoag drugs - and dentist too
  • don’t quickly change food - Vit K increase too fast
111
Q

What do we teach patients about PVD?

A
  1. compression bandages
  2. Damp-dry dressings to ulcers
  3. balanced diet
  4. prevent infection
  5. daily walking
  6. Avoid standing/sitting too long
  7. Reduce swelling- elevate legs
  8. good shoes
112
Q

What is Aortic Aneurysm ?

A

Out pouching or dilation
of the arterial wall
usually caused by
atherosclerosis

113
Q

What are the 2 types of aortic aneurysm?

A

Abdominal
Thoracic

114
Q

What are symptoms of Abdominal aortic aneurysm? (AA)

A
  1. pulsating mass left of midline
  2. Audible Bruits
  3. Pain in back
  4. epigastric pain
  5. GI issues (bowel)
115
Q

What are the symptoms of a thoracic aneurysm?

A
  1. chest pain that radiates across chest to intrascapular area
  2. often asymptomatic but can have trachea issues
116
Q

How do we diagnose abdominal or thorasic aortic aneurysm?

A
  1. CT scan
  2. Ultrasound
    size & location
117
Q

Which type of aortic aneurysm (anterior or posterior) has a poor prognosis and why?

A

Anterior b/c fast bleed into abdominal cavity

118
Q

Which type of aortic aneurysm (anterior or posterior) has a better prognosis and why?

A

Posterior b/c bleeds into retroperitoneal space
- tamponaded by surrounding organs

119
Q

What are 2 non-surgical interventions for aortic aneurysm?

A
  1. monitor growth <5cm
  2. maintain BP WNL
120
Q

What is EVAR (endovascular graft procedure )with aortic aneurysm?

A

stents placed via femoral artery

121
Q

What are 3 important things to monitor after an EVAR?

A
  1. bed rest - leg straight 4-6 hrs
  2. peripheral pulses and groin site
  3. Ischemic complications - emoboli
122
Q

What is Aortic dissection?

A

Tearing of the inner layer of the aorta. Vessel layers separate. life threatening

122
Q

What are signs of someone experiencing Aortic dissection?

A
  1. sudden severe excruciating chest, back, jaw pain (aortic arch)
  2. decreased CO
  3. decreased LOC, weak corotid & temporal pulses
  4. Pain in back and abdomen & legs (descending aorta)
123
Q

What are 3 complications of Aortic dissection?

A
  1. cardiac tamponade
  2. aortic rupture
  3. occlusion of blood supply to organs ie) kidneys
124
Q

what is the goal of aortic dissection intervention?

A

prevent rupture and progression of dissection

125
Q

Which vitals should someone post DVT monitor everyday ?

A

HR
BP

NURS 3512 acute & chronic (29 decks)

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